Long-Term Antipsychotic Use May Reduce Brain Volume

Until recently, doctors and researchers had believed that brain volume loss in schizophrenia was caused primarily by the disease itself. One recent study, however, questions this long-held belief and identifies antipsychotics, the medications most commonly used to treat schizophrenia, as the more likely culprits.

With the increased long-term use of antipsychotics to treat schizophrenia and other forms of mental illness, especially bipolar mania, it’s important to determine whether the illness or the medication (or both) contribute to the potential loss of brain volume.

In an article published in the Archives of General Psychiatry (February, 2011) entitled “Long-term Antipsychotic Treatment and Brain Volumes,” Beng-Choon Ho, MRCPsych, et al. conclude the following:

“… antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.”

The study followed 211 patients with schizophrenia who had repeated neuroimaging soon after the onset of the illness and, on average, 3 to 5 scans over a period of 7.2 to 14 years. The study showed the following:

The greater the intensity of antipsychotic treatment, the greater the brain tissue reduction.

More antipsychotic treatment was associated with smaller gray matter and white matter volumes.

Severity of the illness had relatively modest correlations with brain tissue volume reduction.

Alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted.

Note that the researchers do not conclude from this study that patients should avoid taking antipsychotics. They conclude only that doctors and patients need to carefully assess the risk-benefit ratio of dosage, duration of treatment, and off-label use. As we point out in Bipolar Disorder For Dummies and in numerous posts on this blog, all medications have potentially negative side effects. Doctors and patients must work together to discover the most effective treatment regimens with the least undesirable side-effect profile.